A dentist accused of 46 counts of malpractice insists he spotted a cancerous tongue lesion – despite claims he only prescribed mouthwash, a court has heard.

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Philip Lamey, a professor at the School of Dentistry at the Royal Victoria Hospital in Belfast, allegedly failed to offer a 78-year-old woman patient a cancer biopsy test at four separate appointments, instead prescribing iron supplements and mouthwash.

However, lawyers representing Lamey insisted that at the third appointment, in May 2009, he did suggest "further investigation" was required as the ulcer had not cleared up.

It is at this point Lamey wrote in his notes that the patient, known as Patient 3, refused a biopsy.

The patient's daughter, who appeared in front of the General Dental Council (GDC) yesterday, denied the claims.

Prof Lamey is facing a total of 46 charges involving 33 patients, four of whom later died of cancer.

Under cross-examination from Prof Lamey's counsel, Fiona Neale the patient's daughter, identified only as Mrs F, said: "I am adamant that at no point in that meeting (in May 2009) that the word biopsy was mentioned.

"All the way along in this process we believed we were dealing with a mouth ulcer."

Asked why she did not ask further questions on her mother's treatment at the meeting, she said: "This was a professor I was dealing with, the top man in the country we thought."

Mrs F, who has a degree in biology, said Prof Lamey decided to remove the 'ulcer' on her mother's fourth appointment in October 2009, though Ms Neale said this was a pre-arranged biopsy.

The cancer was finally revealed at a fifth follow-up meeting, which Mrs F did not attend as she was nine months pregnant.

Ms Neale said: "As a biology graduate and an educated woman you would know that tissue would be analysed.

"I suggest that you knew this was a biopsy and that your mother was told she would get the results at a fifth appointment."

Mrs F, who admitted to being out of the room when her mother was having the surgery, replied: "I was not told this. As far as I am aware this did not happen. My mother would have told me.

"All the way through and even on that fourth appointment there was no talk of a biopsy.

"When I found out about it I was totally shocked. We didn't even know the test was being done."

Despite the delay in diagnosis patient 3 made a full recovery following surgery to remove the cancer.

Earlier yesterday, the court heard how the dentist failed to spot a tumour in a separate patient's jawbone, instead prescribing sugar-free chewing gum.

David Bradly, counsel for the GDC, told the hearing: "Professor Lamey gave a diagnosis of temporomandibular joint dysfunction (TMD) and prescribed sugar-free chewing gum for treatment and said he would see her in three months.

"She actually had a tumour in the mandible and was admitted to hospital."

In total 15 patients treated by Mr Lamey, later found to have cancer, may have had a delay in diagnosis, the court heard.

A total of 135 of his patients were recalled to the hospital over misdiagnosis fears, it was said

The hearing continues.

Story so far

Concerns over the work of Prof Philip Lamey first became public in February 2011 when the Belfast Health and Social Care Trust recalled more than 100 patients for further tests. The Trust said there were concerns about 18 patients, including some who had subsequently been diagnosed with cancer. Four have since died. Prof Lamey is facing a total of 46 charges involving 33 patients.